Provider Demographics
NPI:1922750496
Name:MINDFUL RECOVERY CENTER INC
Entity Type:Organization
Organization Name:MINDFUL RECOVERY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:ESMAILIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-600-0060
Mailing Address - Street 1:2629 FOOTHILL BLVD # 550
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-3511
Mailing Address - Country:US
Mailing Address - Phone:818-251-8024
Mailing Address - Fax:
Practice Address - Street 1:210 S KENWOOD ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-5108
Practice Address - Country:US
Practice Address - Phone:818-251-8024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)